Racial and ethnic disparities in use of psychotherapy: Evidence from U.S. National Survey Data

Objective: This study investigated racial and ethnic disparities in psychotherapy use and expenditures in the United States and identified important factors associated with these disparities. Methods: Using the Medical Expenditure Panel Survey from 1996 to 2006, the investigators performed bivariate and multivariable analyses to estimate racial and ethnic disparities in the probability of receiving any psychotherapy, total psychotherapy expenditures, and out-of-pocket-payment share for 7,376 patients with depressive or anxiety disorders. Blinder-Oaxaca decomposition techniques were used to identify the most important factors associated with these disparities. Results: Caucasians were more likely to use psychotherapy than Latinos (57% versus 52%, p<.001), but there was no significant difference between Caucasians and African Americans in the probability of receiving any psychotherapy. Caucasians self-paid 29% of the total cost for each visit, significantly higher than the shares paid by Latinos (19%) and African Americans (14%). Racial-ethnic differences in the propensity to utilize psychotherapy vanished in multivariable regression, but Caucasians still paid a significantly higher out-of-pocket share than others. English proficiency was the most important factor associated with racial-ethnic disparities in psychotherapy use. The extensive Medicaid coverage among Latinos and African Americans was the main reason for their lower out-of-pocket payment for psychotherapy compared with Caucasians. Conclusions: This study found little evidence of racial and ethnic disparities in access to psychotherapy services. Health care reforms affecting mental health coverage under Medicaid would significantly affect psychotherapy expenditure and use among Latinos and African Americans.